Advance Directives (ADs) are Living Wills or Durable Powers of Attorney for health care. They are intended to give health care providers guidelines for patient care decisions in the event of a patient's incompetence. Research indicates, however, that having an AD does not impact health care providers decisions regarding the patient near the patient's end of life. There are guidelines for nurses about their professional responsibilities related to ADs but there is little research about nurses and ADs and the role of nurses in how ALDs are actually used, in practice. The specific aim of this study is to examine nurses' perceptions of and their role in, how ADs are or not integrated into decisions made about patient care near the end of life. A grounded theory study design incorporating in-depth interviewing, field study, participant observation, theoretical sampling, and constant comparative dimensional analysis will be used. Enhanced understanding about the use of ADs in caring for dying patients can provide information that will better nurses' ability to provide patient-centered care at the end of life. The project here proposed is the first study in a program of research with long range objectives that include: optimizing nursing interventions for patient s for patients near the end of life; gaining insight into how public policy, professional ethics, the law, and nursing knowledge is translated into clinical nursing practice, and furthering development of nursing theory in this important area.